Temple Health broke national records in 2025 with 179 lung transplants and continues to lead the nation in volume. Behind that volume is a multidisciplinary care model built around patients with advanced lung disease who have moved beyond conventional treatment.
Becker’s Healthcare spoke with Gerard Criner, MD, Chair and Professor of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine at Temple University and Director of the Temple Lung Center, about the infrastructure and experience required to sustain significant lung transplant volume, the organizational challenges health systems often underestimate and the role of academic medicine in driving responsible growth.
Editor’s note: Responses have been edited for length and clarity.
Question: What’s been your strategy behind growing your program and how have you built the infrastructure to support it?
Dr. Gerard Criner: A program like this is built on multidisciplinary care. It requires individuals from many disciplines working together seamlessly to help patients with advanced lung disease who have exhausted other options. We see a large volume of patients with COPD, emphysema and interstitial lung diseases who continue to decline despite novel therapies.
Transplant is the epitome of a team sport. Everyone works in close integration to maximize the patient’s condition so that the procedure and post-transplant care can occur with the level of success patients and providers want to achieve.
Q: How do you operationalize that team-based model at scale?
GC: At any one time, we have about 40 transplant patients in the hospital. There might be a day or two when no transplants are done, then a day when two or three need to happen. You have to handle the surge.
That requires a large team: pulmonary and critical care physicians, surgical staff, anesthesia, nurse practitioners, a rehab team, pharmacists and psychologists. Hospitalized patients are evaluated within three to five days; outpatients within two to three weeks. From there, a multidisciplinary committee decides on a care plan and lists them. Based on CAS score and other factors, about half of our patients are transplanted within two months.
Q: For health systems looking to grow their transplant programs, what is the most underestimated organizational challenge?
GC: You have to work closely with hospital administration so they understand the infrastructure required, and you have to support everyone, not just your primary group. That means the lab, pathology, transportation, environmental services and the pulmonary function and CT techs. Engage them so they want to work with the program.
The second piece is that transplant patients don’t appear simply because you have a transplant center. You need an advanced lung program that serves as the pipeline. And when patients come in who aren’t candidates for transplant, you have to offer something else.
Q: As patient acuity rises and donor criteria expand, how do you balance growth with quality and outcomes?
GC: Volume isn’t the factor that drives a program; quality outcomes are short- and long-term. That said, there is real expertise that comes with volume. When you do a lot of these cases, you see nuances in individual patients and learn from them as a group.
Once you’re caring for 1,200, 1,500 or 1,800 surviving transplant patients, you need structured programs to maximize their outcomes. One of the major challenges in lung transplant is chronic lung allograft dysfunction. You need an integrated program to monitor patients long-term, detect early manifestations, adjust treatment and conduct the clinical research that produces novel therapies.
Q: What role does academic medicine play in driving innovation, and what advice would you offer leaders trying to scale?
GC: I learned in my training that a good doctor treats a disease — a great doctor treats the patient. Build a program based on evidence-based medicine and contribute to developing that evidence to support the therapies you deliver. We need to be compassionate, smart about the disease and able to treat every patient thoroughly.
More programs engaging patients with advanced lung disease will improve outcomes. The future is studying these diseases so we can change their trajectory, so that fewer patients reach the point of needing transplants.
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